Antenatal Care and Screening Flashcards
Characteristics of morning sickness if pregnancy
- Reasons unclear
- Affects 80-85% women
- Worse in conditions where HCG is higher e.g. twins, molar pregnancy
- Can progress to hyperemesis gravidarium
- Usually much better by week 16
What are the normal physiological cardiac out-put changes in pregnancy
- CO increases by 30-50%
- CO=SV x HR, HR increases from 70-90bpm
- Palpitations common
- At term, blood flow to uterus must exceed 1L/min
What are the normal physiological BP changes in pregnancy
- Drops in the second trimester
- Expansion of the uteroplacental circulation
- A fall in systemic vascular resistance
- Reduction in blood viscosity
- Reduction in sensitivity to angiotensin
- BP return to normal in 3rd trimester
What are the normal physiological changes to the urinary system in pregnancy
- Bladder capacity reduced in 3rd trimester because of pressure
- Increased urine output
- Renal plasma flow increases 25-30%
- Glomerular filtration rate increases by 50%
- Serum urea and creatinine decrease - partly due to increased GFR and partly due to dilutional effect on increased plasma
- UTI
- Increase in urinary stasis
- Hydronephrosis physiological in 3rd trimester and makes pyelonephritis common
- Associated with preterm labour so needs treated
Normal physiological respiratory changes in pregnancy
- Progesterone acts centrally - reduced CO2
- Increased tidal volume
- Increased respiratory
- Increased plasma pH
- O2 consumption increased by 20%
- Plasma PO2 unchanged
- Hyperaemia of resp mucous membranes
Normal physiological GI changes in pregnancy
- Oesophageal peristalsis reduced
- Gastric emptying slows
- Cardiac sphincter relaxes
- GI motility reduced due to
- Increased progesterone
- Decreased motilin
Who gets prepregnancy counselling
- Ideally all women
- Vital for women with previous health or pregnancy problems
- In Scotland 1/3rd pregnancies unplanned
Primary care pre-pregnancy counselling
- General health measures
- Improve diet
- Optimise BMI
- Reduce alcohol consumption
- Smoking cessation advice
- Folic acid - 400mcg
What problems does obesity have in pregnancy
- Higher rate of poorer outcomes
- Affects function of uterus
- Routine measurements difficult
- Venous thromboembolic events more common
What problems does alcohol have in pregnancy
- Foetal abnormalities
- Foetal alcohol syndrome
What problems does age have in pregnancy
- Teenagers more socially deprived, smoke more, book late, do not receive proper antenatal care
- Older women (>40) have a higher chance of pre-existing medical conditions, develop more complications (gestational diabetes, hypertension etc.) an have dramatic increase in chances of chromosomal disorders
What problems does parity have in pregnancy
- Pre-eclampsia is predominantly a condition of mull parity, occurring in the first pregnancy
- Gran multiparity (4 or more) predisposes women to post-partum haemorrhage
What problems does occupation have in pregnancy
- May put themselves or foetus at risk
- Busy jobs with inadequate periods of rest, exposure to substances
What problems does substance misuse have in pregnancy
- Mother may not see antenatal care
- Heroin, methadone and benzodiazepine are addictive to the foetus and cause withdrawal syndrome at birth
- Cocaine is associated with abruption resulting foetal death
Hoe does prepregnancy counselling help those with pre-existing medical conditions
- Optimise maternal health
- Psychiatric health important
- Stop/change unsuitable drugs
- Advise regarding complications associated with maternal medical problems
- Occasional advise against pregnancy
